Abstract
Aim: To propose new guidelines in the management of supracondylar fractures treated by percutaneous Kirschner wires
Subjects and Method: We audited 62 children with displaced, unstable supracondylar fractures of the humerus, which were fixed with Kirschner wire over a period of 2 years. The fractures were classified according to the Wilkins modification of the Gartland system. 10% were type II and 90% type III. The protocol followed was that all unstable fractures that required closed or open reduction must be stabilised with Kirschner wires of adequate thickness used in a crossed configuration and supplemented with back slab. They were then followed up mostly weekly, often with multiple check X-rays until 3 weeks, and for wire removal at 3 weeks. The parameters studied are level of surgeon, adequacy of intra operative reduction, re operation rate, adequacy of intra operative X-rays, out of hour operations, number of post operative X-rays, number of follow ups and any complications.
Results:
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Two patients had re operation due to poor intra operative reduction which were performed by junior grade surgeon without supervision during out of hours.
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No fracture had displaced at follow up when compared with the intra operative X-ray when properly reduced and wired.
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One child had ulnar neuropraxia post operatively
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One child had superficial infection, which settled with oral antibiotics.
Conclusions: Unnecessary radiation can be avoided by obtaining adequate intra operative X-rays and avoiding check X-ray as no fracture had displaced at follow up.
New guidelines proposed:
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Patients with no N-V complications can wait till the morning trauma list.
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All intraoperative X-rays to be reviewed by consultants before discharging home.
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3 weeks appointment for wire removal can be set at one week clinic follow up with out X-ray.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
